Search

Beavers and their dams, once common in small streams throughout Eurasia and North America, are returning to their original range. Beaver dams are special habitats in the aquatic-terrestrial interface, but their macroinvertebrate fauna is hardly known. This study aims to qualify and quantify the invertebrate fauna of beaver dams, taking into account the maintenance status of the dams. Nine different areas covering the top, middle and base zones of eight maintained and eight abandoned beaver dams were sampled using a specially designed suction device. The invertebrate community of beaver dams proved to be diverse and predominantly rheophilic. Community composition reflects higher flow velocities in streamside habitats; this gradient is more pronounced in maintained than in abandoned dams. Shredders are the most abundant feeding type, but they are less frequent in streamside habitats, in particular in those of maintained dams, where passive filter feeders prevail. Terrestrial/Semiaquatic taxa colonising hygropetric areas were found in streamside habitats especially of abandoned dams. Our results underline that beaver dams provide a wide variety of environmental conditions and habitat types, which enhance biodiversity in small streams and their floodplains. Beaver dams in riverine landscapes should therefore be much more valued in floodplain conservation and management.

Postoperative mortality for oropharynx squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) varies from 0.2% to 6.5% on trials; the real-world rate is unknown.NCDB study from 2010 to 2017 for patients with cT1-2N0-2M0 OPSCC with Charleson-Deyo score 0-1. Ninety-day mortality assessed from start and end of treatment at Commission on Cancer-accredited facilities.3639 patients were treated with TORS and 1937 with radiotherapy. TORS cohort had more women and higher income, was younger, more often treated at academic centers, and more likely to have private insurance (all p 0.05). Ninety-day mortality was 1.3% with TORS and 0.7% or 1.4% from start or end of radiotherapy, respectively. From end of therapy, there was no significant difference on MVA between treatment modality.There is minimal difference between 90-day mortality in patients treated with TORS or radiotherapy for early-stage OPSCC. While overall rates are low, for patients with expectation of cure, work is needed to identify optimal treatment.

Standard of care for lower-grade glioma (LGG) is maximal safe resection and risk-adaptive adjuvant therapy. While patients who benefit the most from adjuvant chemotherapy have been elucidated in prospective randomized studies, comparable insights for adjuvant radiotherapy (RT) are lacking. We sought to identify and validate patterns of gene expression that are associated with differential outcomes among LGG patients treated by RT from two large genomics databases.Patients from The Cancer Genome Atlas (TCGA) with LGG (WHO grade II-III glioma) treated by surgery and adjuvant RT were randomized 1:1 to a discovery cohort or an internal validation cohort. Using the discovery cohort only, associations between tumor RNA-seq expression and progression-free survival (PFS) as well as overall survival (OS) were evaluated with adjustment for clinicopathologic covariates. A Genomic Risk Score (GRS) was then constructed from the expression levels of top genes also screened for involvement in glioma carcinogenesis. The prognostic value of GRS was further assessed in the internal validation cohort of TCGA and a second distinct database, compiled by the Chinese Glioma Genome Association (CGGA).From TCGA, 289 patients with LGG received adjuvant RT alone (38 grade II, 30 grade III) or chemoradiotherapy (CRT) (51 grade II, 170 grade III) between 2009 and 2015. From CGGA, 178 patients with LGG received adjuvant RT alone (40 grade II, 13 grade III) or CRT (41 grade II, 84 grade III) between 2004 and 2016. The genes comprising GRS are involved in MAP kinase activity, T cell chemotaxis, and cell cycle transition: MAP3K15, MAPK10, CCL3, CCL4, and ADAMTS1. High GRS, defined as having a GRS in the top third, was significantly associated with poorer outcomes independent of age, sex, glioma histology, WHO grade, IDH mutation, 1p/19q co-deletion, and chemotherapy status in the discovery cohort (PFS HR 1.61, 95% CI 1.10-2.36, P = 0.014; OS HR 2.74, 95% CI 1.68-4.47, P 0.001). These findings were replicated in the internal validation cohort (PFS HR 1.58, 95% CI 1.05-2.37, P = 0.027; OS HR 1.84, 95% CI 1.13-3.00, P = 0.015) and the CGGA external validation cohort (OS HR 1.72, 95% CI 1.27-2.34, P 0.001). Association between GRS and outcomes was observed only among patients who underwent RT, in both TCGA and CGGA.This study successfully identified an expression signature of five genes that stratified outcomes among LGG patients who received adjuvant RT, with two rounds of validation leveraging independent genomics databases. Expression levels of the highlighted genes were associated with PFS and OS only among patients whose treatment included RT, but not among those with omission of RT, suggesting that expression of these genes may be predictive of radiation treatment response. While additional prospective studies are warranted, interrogation of these genes may be considered in the multidisciplinary management of LGG.

Salinisation has direct and detrimental physiological effects on freshwater organisms, yet little is known about its indirect effects. Here, we present a study that investigated the primary and secondary effects of salinisation on aquatic macroinvertebrates. We analysed macroinvertebrate samples from nine sites in river Wipper, Germany against nine stressor variables (water quality, salinisation, hydromorphological degradation). A Principal Component Analysis showed water quality deterioration and physical habitat degradation to constitute the main stressor gradients. Two macroinvertebrate community metrics (index of general degradation and percent Ephemeroptera-Plecoptera-Trichoptera specimens) revealed strong and significant positive correlations with water quality, but only weak and insignificant positive correlations with hydromorphological quality. High-resolution temporal measurements revealed notable oxygen deficits at a salinised and macrophyte-rich site that was dominated by the salt-tolerant macrophyte species Stuckenia [Potamogeton] pectinata (L.) Börner. At the site, oxygen levels frequently dropped below 6 mg/L during nighttime, suggesting an interaction of osmoregulatory stress (through salinisation) and respiratory stress (through plant mitochondrial respiration) that is caused by the mass development of a salt-tolerant macrophyte species. This biologically driven interaction of direct and indirect salinisation effects adds another level of complexity to the influence of multiple stressors in lotic systems and requires consideration in river management and restoration.

Es wird uber einen multimorbiden Patienten berichtet, bei dem es durch ein Nierenversagen im Rahmen einer akuten intestinalen Erkrankung zu einer akzidentellen Uberdosierung mit Dabigatran und folgender intrapulmonaler Blutung kam. Die Steuerung einer hochdosierten und weit uber den Herstellerangaben liegenden Idarucizumabtherapie war durch eine Thrombelastographie (TEG) differenzierter moglich als mit konventionellen Laborparametern. In der Diskussion werden die spezifischen Anderungen im kaolinaktivierten CK-Test und dessen entscheidenden Parameter („R-Zeit“) im Behandlungsverlauf dargestellt.

Atherosclerosis - the pathophysiological mechanism shared by most cardiovascular diseases - can be directly or indirectly assessed by a variety of clinical tests including measurement of carotid intima-media thickness, carotid plaque, ankle-brachial index, pulse wave velocity, and coronary artery calcium. the Prospective Studies of Atherosclerosis (Proof-ATHERO) consortium (https://clinicalepi.i-med.ac.at/research/proof-athero/) collates de-identified individual-participant data of studies with information on atherosclerosis measures, risk factors for cardiovascular disease, and incidence of cardiovascular diseases. It currently comprises 74 studies that involve 106,846 participants from 25 countries and over 40 cities. in summary, 21 studies recruited participants from the general population (n = 67,784), 16 from high-risk populations (n = 22,677), and 37 as part of clinical trials (n = 16,385). Baseline years of contributing studies range from April 1980 to July 2014; the latest follow-up was until June 2019. Mean age at baseline was 59 years (standard deviation: 10) and 50% were female. Over a total of 830,619 person-years of follow-up, 17,270 incident cardiovascular events (including coronary heart disease and stroke) and 13,270 deaths were recorded, corresponding to cumulative incidences of 2.1% and 1.6% per annum, respectively. the consortium is coordinated by the Clinical Epidemiology Team at the Medical University of Innsbruck, Austria. Contributing studies undergo a detailed data cleaning and harmonisation procedure before being incorporated in the Proof-ATHERO central database. Statistical analyses are being conducted according to pre-defined analysis plans and use established methods for individual-participant data meta-analysis. Capitalising on its large sample size, the multi-institutional collaborative Proof-ATHERO consortium aims to better characterise, understand, and predict the development of atherosclerosis and its clinical consequences. (c) 2020 S. Karger AG, Basel, Austrian Science Fund (FWF)Austrian Science Fund (FWF) [P 32488]; Dr.-Johannes-and-Hertha-Tuba Foundation, This work was funded by the Austrian Science Fund (FWF) (P 32488) and the Dr.-Johannes-and-Hertha-Tuba Foundation. Funders of individual studies contributing to the present analysis arelisted onthe Proof-ATHERO webpage(https://clinicalepi.i-med.ac.at/research/proof-athero/studies/).

The present study provides new insight into suitable microsporidian–host associations. It relates regional and continental-wide host specialization in microsporidians infecting amphipods to degraded and recovering habitats across 2 German river catchments. It provides a unique opportunity to infer the persistence of parasites following anthropogenic disturbance and their establishment in restored rivers. Amphipods were collected in 31 sampling sites with differing degradation and restoration gradients. Specimens were morphologically (hosts) and molecularly identified (host and parasites). Amphipod diversity and abundance, microsporidian diversity, host phylogenetic specificity and continental-wide β-specificity were investigated and related to each other and/or environmental variables. Fourteen microsporidian molecular operational taxonomic units (MOTUs), mainly generalist parasites, infecting 6 amphipod MOTUs were detected, expanding the current knowledge on the host range by 17 interactions. There was no difference in microsporidian diversity and host specificity among restored and near-natural streams (Boye) or between those located in urban and rural areas (Kinzig). Similarly, microsporidian diversity was generally not influenced by water parameters. In the Boye catchment, host densities did not influence microsporidian MOTU richness across restored and near-natural sites. High host turnover across the geographical range suggests that neither environmental conditions nor host diversity plays a significant role in the establishment into restored areas. Host diversity and environmental parameters do not indicate the persistence and dispersal of phylogenetic host generalist microsporidians in environments that experienced anthropogenic disturbance. Instead, these might depend on more complex mechanisms such as the production of resistant spores, host switching and host dispersal acting individually or conjointly.

Aquatic macroinvertebrates are considered effective bioindicators of ecosystem health due to their different sensitivities to habitat alteration and pollution. Macroinvertebrate community structures can be assessed using commonly used diversity-based approaches, however, functional trait-based approaches are increasingly introduced into bioassessments. The Hex River is subjected to intensive mining activities, while urban and industrial effluents, as well as treated and untreated sewage also contributes to pollution in the river. The present study aimed to assess macroinvertebrate responses to different stressors (nutrient and chemical, especially metal pollutants), determine whether diversity-based or trait-based approaches provide a better indication of responses and, to evaluate the relationship between metal bioaccumulation and macroinvertebrate responses to this multi-stressor environment. The mining impacts, in combination with urban, industrial and sewage effluent, altered the macroinvertebrate community structure of the Hex River. The species richness significantly decreased from reference conditions (39 species) to impacted conditions (24 species), while the total number of individuals in tolerant species gradually increased. The diversity-based approach indicated a clear difference between reference and impacted conditions but did not clearly differentiate between different stressors, while the trait-based approach distinguished the urban, industrial and sewage effluent sites from mining impacted sites. The use of both approaches is, therefore, recommended as both complement each other. From the present study, it is evident that macroinvertebrates can be considered as both reliable accumulation-, and response bioindicators to pollution from mining, as well as urban and industrial activities.

Introduction Comprehensive treatment of Herpes-simplex-virus-encephalitis (HSVE) remains a major clinical challenge. The current therapy gold standard is aciclovir, a drug that inhibits viral replication. Despite antiviral treatment, mortality remains around 20% and a majority of survivors suffer from severe disability. Experimental research and recent retrospective clinical observations suggest a favourable therapy response to adjuvant dexamethasone. Currently there is no randomized clinical trial evidence, however, to support the routine use of adjuvant corticosteroid treatment in HSVE. Methods The German trial of Aciclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE) studied the effect of adjuvant dexamethasone versus placebo on top of standard aciclovir treatment in adult patients aged 18 up to 85 years with proven HSVE in German academic centers of Neurology in a randomized and double blind fashion. The trial was open from November 2007 to December 2012. The initially planned sample size was 372 patients with the option to increase to up to 450 patients after the second interim analysis. The primary endpoint was a binary functional outcome after 6 months assessed using the modified Rankin scale (mRS 0–2 vs. 3–6). Secondary endpoints included mortality after 6 and 12 months, functional outcome after 6 months measured with the Glasgow outcome scale (GOS), functional outcome after 12 months measured with mRS and GOS, quality of life as measured with the EuroQol 5D instrument after 6 and 12 months, neuropsychological testing after 6 months, cranial magnetic resonance imaging findings after 6 months, seizures up to day of discharge or at the latest at day 30, and after 6 and 12 months. Results The trial was stopped prematurely for slow recruitment after 41 patients had been randomized, 21 of them treated with dexamethasone and 20 with placebo. No difference was observed in the primary endpoint. In the full analysis set (n = 19 in each group), 12 patients in each treatment arm achieved a mRS of 0–2. Similarly, we did not observe significant differences in the secondary endpoints (GOS, mRS, quality of life, neuropsychological testing). Conclusion GACHE being prematurely terminated demonstrated challenges encountered performing randomized, placebo-controlled trials in rare life threatening neurological diseases. Based upon our trial results the use of adjuvant steroids in addition to antiviral treatment remains experimental and is at the decision of the individual treating physician. Unfortunately, the small number of study participants does not allow firm conclusions. Trial registration EudraCT-Nr. 2005–003201-81.

Assessments of river restoration outcomes are mostly based on taxonomic identities of species, which may not be optimal because a direct relationship to river functions remains obscure and results are hardly comparable across biogeographic borders. The use of ecological species trait information instead of taxonomic units may help to overcome these challenges. Abundance data for fish communities were gathered from 134 river restoration projects conducted in Switzerland, Germany and Finland, monitored for up to 15 years. These data were related to a dataset of 22 categories of ecological traits describing fish life-history strategies to assess the outcome of the restoration projects. Restoration increased trait functional diversity and evenness in projects that were situated in the potamal zone of rivers. Restoration effect increased with the length of the restored river reaches. In areas with low levels of anthropogenic land use, the peak of the restoration effect was reached already within one to five years after the restoration and effect receded thereafter, while communities responded later in areas with higher levels of anthropogenic land use. In the lower potamal zone, a shift towards opportunistic life-history strategists was observed. In the upper rhithral zone, in contrast, species with an opportunistic life-history strategy increased only in the first five years of restoration, followed by a shift towards equilibrium strategists at restorations older than 5 years. This pattern was more pronounced in rivers with higher level of anthropogenic land use and longer restored river reaches. Restoration reduced the variability in community trait composition between river reaches suggesting that community trait composition within these zones converges when rivers are restored. This study showed how ecological traits are suitable to analyse restoration outcomes and how such an approach can be used for the evaluation and comparison of environmental management actions across geographical regions. peerReviewed

Nitrogen and phosphorous concentrations are widely considered to drive macrophyte assemblages in rivers. However, Dissolved Inorganic Carbon (DIC) - available for plants as CO2 and HCO3- - is also of major relevance. Based on literature, we present a conceptual model on the interaction between algae, macrophytes, DIC, pH, light, N, P and the surface water and sedimental compartment. Analysing two separate datasets (i) on river physico-chemistry and chlorophyll-a, and (ii) on river physico-chemistry and macrophytes we quantify three connections within this concept: (1) the correlation of chlorophyll-a versus pH, (2) the correlation of TP versus chlorophyll-a and (3) the occurrence of HCO3-users and CO2-only-users among macrophytes along the DIC gradient. Chlorophyll-a correlated positively with pH (R-squared = 77%, p < .001) due to increased carbon dioxide uptake of phytoplankton. Surface water TP did not linearly correlate with chlorophyll-a concentrations. Obligate and optionally submerged macrophyte species that utilise HCO3- were separated from CO2-only-users by HCO3- concentrations, with an area under the curve (AUC) of 68% and 70% (both p < .001) between groups. Obligate and optionally submerged macrophyte assemblages only composed of HCO3-users and those exclusively composed of CO2-only-users showed an even stronger separation based on the HCO3- concentration, with both an AUC of 82% and 78% (both p < .001). Our results underline that DIC can greatly affect riverine macrophytes. However, absolute concentrations of HCO3- are less relevant, while the connection to pH is more important, reflecting CO2 concentrations. River monitoring and management should consider the interaction between nutrients DIC, surface water and sedimental compartment as important factors affecting macrophyte occurrence, rather than solely focussing on surface water nutrients.

Biotic homogenization is one of the key aspects of the current biodiversity crisis. Here we analyzed the trends of three facets of niche homogenization, i.e. niche specialization, trait α-diversity and spatial β-diversity, over a period of 25 years (1990–2014) using a large dataset of 3782 stream benthic invertebrate samples collected from central European low-mountain streams. We studied a set of traits describing the ecological niche of species and their functions: body size, feeding groups, substrate preferences, flow preferences, stream zonation preferences and saprobity. Trait composition changed significantly during the study period, and we identified an overall increase in niche homogenization. Specifically, community niche specialization significantly decreased by 20.3% over the 25-year period, with declines ranging from −16.0 to −40.9% for zonation-, flow-, substrate-preferences, body size and feeding traits. Trait diversity did not change significantly, although we recorded significant decreases by −14.2% and −10.2% for flow- and substrate-preference and increases by 5.8% and 22.6% for feeding traits and zonation preference over the study period. Trait spatial β-diversity significantly decreased by −53.0%, with substrate-preference, feeding groups and flow-preference traits declining from −61.9% to −75.3% over the study period. This increased niche homogenization is likely driven by the increase of down-stream typical taxa, which are favored by warming temperatures. Further, it is in apparent contradiction with the recorded increase in abundance (+35.9%) and taxonomic richness (+39.2%) over the same period. However, even such increases do not safeguard communities from undergoing niche homogenization indicating that recovery processes may differ with regard to community composition and community traits. Our results emphasize the complexity of community responses to global change and warrant caution when founding conclusions based solely on single community metrics.

Notas: Parece un guion. Procede de un programa cultural de radio animado por Günter W. Lorenz, de la Süddeutscher Rundfunk (SDR): radiodifusora pública alemana para el norte de Baden-Württemberg de 1949 a 1998. Anotaciones manuscritas: "Cronopios y famas" y "Cortázar, Geschichten S.2", y sello "Für den Autor" ("Para el Autor") en la primera página.

Notas: Fotocopia de un artículo donde están apuntados de forma tapuscrita los datos de la publicación en la parte superior izquierda. Sello "Für den Autor" ("Para el Autor") en la parte inferior., Tipo de publicación: Revista, Título de la publicación: Die Welt der Literatur

Water temperature is a key driver for riverine biota and strongly depends on shading by woody riparian vegetation in summer. While the general effects of shading on daily maximum water temperature Tmₐₓ are well understood, knowledge gaps on the role of the spatial configuration still exist. In this study, the effect of riparian buffer length, width, and canopy cover (percentage of buffer area covered by woody vegetation) on Tmₐₓ was investigated during summer baseflow using data measured in seven small lowland streams in western Germany (wetted width 0.8–3.7 m). The effect of buffer length on Tmₐₓ differed between downstream cooling and heating: Tmₐₓ approached cooler equilibrium conditions after a distance of 0.4 km (~45 min travel-time) downstream of a sharp increase in canopy cover. In contrast, Tmₐₓ continued to rise downstream of a sharp decrease in canopy cover along the whole 1.6 km stream length investigated. The effect of woody vegetation on Tmₐₓ depended on buffer width, with changes in canopy cover in a 10 m wide buffer being a better predictor for changes in Tmₐₓ compared to a 30 m buffer. The effect of woody vegetation on Tmₐₓ was linearly related to canopy cover but also depended on daily temperature range Trₐngₑ, which itself was governed by cloudiness, upstream canopy cover, and season. The derived empirical relationship indicated that Tmₐₓ was reduced by −4.6°C and increased by +2.7°C downstream of a change from unshaded to fully shaded conditions and vice versa. This maximum effect was predicted for a 10 m wide buffer at sunny days in early summer, in streams with large diel fluctuations (large Trₐngₑ). Therefore, even narrow woody riparian buffers may substantially reduce the increase in Tmₐₓ due to climate change, especially in small shallow headwater streams with low baseflow discharge and large daily temperature fluctuations.

This article presents the case of a multimorbid male patient with an accidental dabigatran overdose caused by kidney failure in the context of an acute intestinal disorder. After effective initial antagonizing of the dabigatran effect using idarucizumab a dabigatran rebound was detected caused by a single hemodialysis leading to a severe intrapulmonary hemorrhage. As dabigatran plasma level testing was not available and conventional coagulation analysis was out of interpretable range due to the impact of dabigatran, continuous thrombelastography (TEG) was used to detect the effect of dabigatran and monitor the treatment results. The most significant parameter used in the kaolin activated clotting time was the R‑time parameter, which was massively prolonged by the interrupted coagulation cascade.

Although experiences with ecological restoration continue to accumulate, the effectiveness of restoration for biota remains debated. We complemented a traditional taxonomic analysis approach with information on 56 species traits to uncover the responses of 3 aquatic (fish, macroinvertebrates, macrophytes) and 2 terrestrial (carabid beetles, floodplain vegetation) biotic groups to 43 hydromorphological river restoration projects in Germany. All taxonomic groups responded positively to restoration, as shown by increased taxonomic richness (10-164%) and trait diversity (habitat, dispersal and mobility, size, form, life history, and feeding groups) (15-120%). Responses, however, were stronger for terrestrial than aquatic biota, and, contrary to our expectation, taxonomic responses were stronger than those of traits. Nevertheless, trait analysis provided mechanistic insights into the drivers of community change following restoration. Trait analysis for terrestrial biota indicated restoration success was likely enhanced by lateral connectivity and reestablishment of dynamic processes in the floodplain. The weaker response of aquatic biota suggests recovery was hindered by the persistence of stressors in the aquatic environment, such as degraded water quality, dispersal constraints, and insufficient hydromorphological change. Therefore, river restoration requires combined local- and regional-scale approaches to maximize the response of both aquatic and terrestrial organisms. Due to the contrasting responses of aquatic and terrestrial biota, the planning and assessment of river restoration outcomes should consider effects on both components of riverine landscapes.

Species reintroductions – the translocation of individuals to areas in which a species has been extirpated with the aim of re-establishing a self-sustaining population – have become a widespread practice in conservation biology. Reintroduction projects have tended to focus on terrestrial vertebrates and, to a lesser extent, fishes. Much less effort has been devoted to the reintroduction of invertebrates into restored freshwater habitats. Yet, reintroductions may improve restoration outcomes in regions where impoverished regional species pools limit the self-recolonisation of restored freshwaters. We review the available literature on macroinvertebrate reintroductions, focusing on identifying the intrinsic and extrinsic factors that determine their success or failure. Our study reveals that freshwater macroinvertebrate reintroductions remain rare, are often published in the grey literature and, of the attempts made, approximately one-third fail. We identify life-cycle complexity and remaining stressors as the two factors most likely to affect reintroduction success, illustrating the unique challenges of freshwater macroinvertebrate reintroductions. Consideration of these factors by managers during the planning process and proper documentation – even if a project fails – may increase the likelihood of successful outcomes in future reintroduction attempts of freshwater macroinvertebrates.

Background and Purpose: Driven by the positive results of randomized, controlled trials of endovascular stroke therapies (EVT) in stroke patients with large vessel occlusion, different approaches to speed up the workflow for EVT candidates are currently being implemented worldwide. We aimed to assess the effect of a simple stroke network-wide workflow improvement project, primarily focusing on i.v. thrombolysis, on process times for patients undergoing EVT. Methods: In 2015, we conducted a network-wide, peer-to-peer acute stroke workflow improvement program for i.v. thrombolysis with the main components of implementing a binding team-based algorithm at every stroke unit of the regional network, educating all stroke teams about non-technical skills and providing a stroke-specific simulation training. Before and after the intervention we recorded periprocedural process times, including patients undergoing EVT at the 3 EVT-capable centers (January – June 2015, n = 80 vs. July 2015 – June 2016, n = 184). Results: In this multi-centric evaluation of 268 patients receiving EVT, we observed a relevant shortening of the median time from symptom onset to EVT specifically in patients requiring secondary transfer by almost an hour (300 min, 25–75% interquartile range [IQR] 231–381 min to 254 min, IQR 215.25–341 min; p = 0.117), including a reduction of the median door-to-groin time at the EVT-capable center in this patient group by 15.5 min (59 min, IQR 35–102 min to 43.5 min, IQR 27.75–81.25 min; p = 0.063). In patients directly admitted to an EVT-capable center, the median door-to-groin interval was reduced by 10.5 min (125 min, IQR 83.5–170.5 min to 114.5 min, IQR 66.5–151 min; p = 0.167), but a considerable heterogeneity between the centers was observed (p < 0.001). Conclusions: We show that a simple network-wide workflow improvement program primarily directed at fast i.v. thrombolysis also accelerates process times for EVT candidates and is a promising measure to improve the performance of an entire stroke network.

Spezialisierte neurologische Behandlungen verringern die Mortalitat und Morbiditat von Schlaganfallpatienten. In vielen Regionen der Erde ist keine flachendeckende spezialisierte Versorgung verfugbar. Die Kooperation zwischen dem Krankenhaus Nordwest und der Regierung von Brunei Darussalam beschreibt den Aufbau eines neurologischen Zentrums inkl. Stroke-Unit, Rehabilitation und Wissenschaft. Ziel diese Projektes „to teach to treat – to treat to teach“ war es, ein Hochleistungszentrum fur Neurologie in Brunei Darussalam uber eine Distanz von 12.000 km hinweg aufzubauen. Durch Lehre wurden Behandlungsmoglichkeiten erlautert, durch Fallbeispiele wurde gelehrt. Der Aufbau des Brunei Neuroscience Stroke and Rehabilitation Centre (BNSRC) begann im Juli 2010. Zur Uberwindung der Distanz zwischen der Klinik fur Neurologie und Neuroradiologie am Krankenhaus Nordwest, Frankfurt/Main und dem BNSRC wurde ein Telemedizinnetzwerk etabliert. Tagliche telemedizinische Lehrveranstaltungen fur alle an der Betreuung der Patienten beteiligten Berufsgruppen wurden angeboten sowie die 24-Stunden-7-Tage-Erreichbarkeit des deutschen diensthabenden Arztes zur Unterstutzung der Kollegen vor Ort. Im BNSRC wurden im Zeitraum Juli 2010 bis Juli 2016 bisher uber 1000 Patienten mit ischamischen und hamorrhagischen Schlaganfallen und alle die Neurologie betreffenden Krankheitsbilder stationar behandelt. Des Weiteren fanden im ambulanten Bereich uber 5000 Patientenkontakte statt. Seit 2010 konnte bei 52 Patienten eine Lysetherapie erfolgen und 81 Hemikraniektomien durchgefuhrt werden. Das Projekt hat gezeigt, dass es moglich ist, zum Nutzen vieler Menschen spezialisiertes neurologisches Wissen uber eine weite Distanz hinweg zu vermitteln.

South Africa is the world’s main supplier of Pt. The Bushveld Igneous Complex in South Africa contains 75% of the world’s Pt resources. Mining of this precious metal requires large volumes of water for production and removal of waste products. Most of this wastewater is discharged into river systems. Although the source of contamination with Pt in aquatic systems due to mining activities is known, little to no information is available about the impact of Pt on aquatic organisms. Additionally, other metals are released as byproducts of Pt mining, which might also be discharged into the environment. Therefore, concentrations of Cr, Ni, Cu, Zn, Cd, Pt and Pb were determined in water, sediment and macroinvertebrate samples from a reference site (Site 1), a highly impacted site (Site 2) and a moderately impacted site (Site 3) along the Hex River, South Africa. Aquatic invertebrate families representing different functional feeding groups i.e. scraper-grazers (Lymnaeidae), collector-gatherers (Potamonautidae, Hydropsychidae, Tubificidae and Chironomidae), shredders (Baetidae) and predators (Coenagrionidae and Libellulidae) were studied. In the sediments, the concentrations of Cr and Pt were significantly higher at Site 2 than at Sites 1 and 3, respectively, whereas concentrations of Ni, Cu, Cd, and Pb showed no significant differences between the sites. Depending on the metal, the aquatic invertebrate families showed different grades of bioaccumulation. The results from especially Lymnaeidae, Baetidae, Tubificidae and Chironomidae showed great promise for the use of these taxa for biomonitoring of metal contaminations. The macroinvertebrates accumulated metals associated with Pt mining, with epi-benthic dwelling taxa (Tubificidae) accumulating higher concentrations of Pt and Cr than other families (e.g. Potamonautidae, Coenagrionidae and Lymnaeidae). These results provide valuable information on the behavior of metals related to Pt mining in aquatic ecosystems and therefore can contribute to the risk assessment of these intensive mining activities.

"Delta-radiomics" investigates variations in quantitative image metrics over time and can yield important clinical information. We hypothesized that in patients undergoing active radiation therapy (RT) for prostate cancer (PCa), there would exist observable variation in the quantitative metrics that describe the T2-weighted (T2W) intensity histogram in the prostate and surrounding organs at risk (OAR) over time. We investigated the feasibility of acquisition and subsequent analysis of the delta-radiomic profiles of these regions of interest (ROI) in serial T2W magnetic resonance (MR) images obtained on a 1.5 Tesla (T) Magnetic Resonance Linear Accelerator (MRL). Principally, we sought to illustrate the significance of longitudinal radiomic data acquisition for tissue response monitoring and provide a framework for future hypothesis driven research. Patients with PCa undergoing treatment with RT were compiled from an ongoing prospective observational imaging trial using a 1.5 T MRL (NCT30500081). Contiguous axial slices of prostate parenchyma were contoured and temporally normalized to sections of Sartorius muscle which served as a control. Similarly, contiguous sections of rectal and bladder wall adjacent to the prostate were contoured and temporally normalized to regions of these organs further removed from the planning target volume (PTV). First order statistical descriptors of the T2W intensity histogram were extracted and evaluated for changes over time using linear mixed effects regression modeling and post-hoc contrasts. Benjamini-Hochberg corrections were employed to reduce the effects of multiple testing and control for the false discovery rate (FDR). Four patients with a median age of 69 comprised this exploratory cohort. One patient had low-risk disease, two had intermediate (one favorable, one unfavorable), and one had high risk disease. Three out of four patients underwent definitive radiation to 75.6 Gray (Gy) in 42 fractions and one received hypofractionated therapy to a total dose of 70 Gy over 28 fractions, and all received treatment on a conventional linear accelerator. The most significant acute toxicity event was grade 2 GU dysfunction observed in two patients. Follow up ranged from 1 month to 10 months post treatment, and no long-term complications were reported in patients who completed treatment at least one month prior. Bladder wall adjacent to the prostate demonstrated significant variation in the mean and median metric values after the first week of treatment. In addition, rectal wall adjacent to the prostate exhibited significant variation in the mean, median, and standard deviation metric values by the second week of treatment. No significant variation in any radiomic feature was observed in the Sartorius control. This exploratory study is one of the earliest examining the delta-radiomic characteristics of the T2W intensity histogram in OAR extracted from images acquired on a 1.5 T MRL in patients actively being treated with RT for PCa. We demonstrated a feasible approach to longitudinal radiomic data acquisition providing limitless opportunity for future research. Analysis of the delta-radiomic profiles in OAR revealed significant variation in metrics after only one week of RT in bladder and rectal wall adjacent to the prostate. These findings must be further investigated and validated with expanded data sets with long-term follow up and correlation to clinical outcomes including toxicity and tumor control.

In this case report, we describe the pathologic changes and the ultrastructural and molecular characteristics of an adenovirus in a sun conure (

AimsAveraged measurements, but not the progression based on multiple assessments of carotid intima-media thickness, (cIMT) are predictive of cardiovascular disease (CVD) events in individuals. Whether this is true for conventional risk factors is unclear.Methods and resultsAn individual participant meta-analysis was used to associate the annualised progression of systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol with future cardiovascular disease risk in 13 prospective cohort studies of the PROG-IMT collaboration ( n = 34,072). Follow-up data included information on a combined cardiovascular disease endpoint of myocardial infarction, stroke, or vascular death. In secondary analyses, annualised progression was replaced with average. Log hazard ratios per standard deviation difference were pooled across studies by a random effects meta-analysis. In primary analysis, the annualised progression of total cholesterol was marginally related to a higher cardiovascular disease risk (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.00 to 1.07). The annualised progression of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol was not associated with future cardiovascular disease risk. In secondary analysis, average systolic blood pressure (HR 1.20 95% CI 1.11 to 1.29) and low-density lipoprotein cholesterol (HR 1.09, 95% CI 1.02 to 1.16) were related to a greater, while high-density lipoprotein cholesterol (HR 0.92, 95% CI 0.88 to 0.97) was related to a lower risk of future cardiovascular disease events.ConclusionAveraged measurements of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol displayed significant linear relationships with the risk of future cardiovascular disease events. However, there was no clear association between the annualised progression of these conventional risk factors in individuals with the risk of future clinical endpoints.

Background The clinical use of carotid intima media thickness (cIMT) requires normal values, which may be subject to variation of geographical factors, ethnicity or measurement details. The influence of these factors has rarely been studied. The aim of this study was to determine whether normative cIMT values and their association with event risk are generalizable across populations. Design Meta-analysis of individual participant data. Method From 22 general population cohorts from Europe, North America and Asia we selected subjects free of cardiovascular disease. Percentiles of cIMT and cIMT progression were assessed separately for every cohort. Cox proportional hazards models for vascular events were used to estimate hazard ratios for cIMT in each cohort. The estimates were pooled across Europe, North America and Asia, with random effects meta-analysis. The influence of geography, ethnicity and ultrasound protocols on cIMT values and on the hazard ratios was examined by meta-regression. Results Geographical factors, ethnicity and the ultrasound protocol had influence neither on the percentiles of cIMT and its progression, nor on the hazard ratios of cIMT for vascular events. Heterogeneity for percentiles of cIMT and cIMT progression was too large to create meaningful normative values. Conclusions The distribution of cIMT values is too heterogeneous to define universal or regional population reference values. CIMT values vary widely between different studies regardless of ethnicity, geographic location and ultrasound protocol. Prediction of vascular events with cIMT values was more consistent across all cohorts, ethnicities and regions.

A large number of restoration projects aims to improve the ecological quality of streams and rivers by focusing on the stream structure. However, improved habitat heterogeneity often does not lead to natural recolonization by sensitive freshwater macroinvertebrate communities, particularly when the recolonization potential is low and source populations are absent. In preliminary studies we tested whether natural substrate exposures could be used to sample and transport benthic macroinvertebrates. In this pilot study we used these previously tested natural substrate exposures to sample freshwater invertebrates in a donor stream in order to actively (re-)colonize a recipient stream. In the course of three reintroduction campaigns, we were able to accumulate over 350,000 benthic invertebrates, including 25 indicator taxa of the orders Ephemeroptera, Plecoptera and Trichoptera and 30 taxa scoring positive in the German Fauna Index. In total, 45 taxa, which did not occur in the recipient stream before, were reintroduced. They were transported gently within natural substrate exposures and released on a stream bottom area of 500 m2 in the recipient stream. We intended to study if an increase of benthos fauna in a recipient stream is possible, and if this increase will eventually improve the ecological status. So far, the natural substrate exposure-method demonstrated to be an adequate tool to accumulate and transport benthic macroinvertebrates and, in general, has the potential to increase the biodiversity of streams when used as assisted migration measure.

Climate warming often results in species range shifts, biodiversity loss and accumulated climatic debts of biota (i.e. slower changes in biota than in temperature). Here, we analyzed the changes in community composition and temperature signature of stream invertebrate communities over 25 years (1990-2014), based on a large set of samples (n = 3782) over large elevation, latitudinal and longitudinal gradients in central Europe. Although warming was moderate (average 0.5 °C), we found a strong reorganization of stream invertebrate communities. Total abundance (+35.9%) and richness (+39.2%) significantly increased. The share of abundance (TA) and taxonomic richness (TR) of warm-dwelling taxa (TA: +73.2%; TR: +60.2%) and medium-temperature-dwelling taxa (TA: +0.4%; TR: +5.8%) increased too, while cold-dwelling taxa declined (TA: -61.5%; TR: -47.3%). The community temperature index, representing the temperature signature of stream invertebrate communities, increased at a similar pace to physical temperature, indicating a thermophilization of the communities and, for the first time, no climatic debt. The strongest changes occurred along the altitudinal gradient, suggesting that stream invertebrates use the spatial configuration of river networks to track their temperature niche uphill. Yet, this may soon come to an end due to the summit trap effect. Our results indicate an ongoing process of replacement of cold-adapted species by thermophilic species at only 0.5 °C warming, which is particularly alarming in the light of the more drastic climate warming projected for coming decades.

Both ecosystem structure and functioning determine ecosystem status and are important for the provision of goods and services to society. However, there is a paucity of research that couples functional measures with assessments of ecosystem structure. In mid-sized and large rivers, effects of restoration on key ecosystem processes, such as ecosystem metabolism, have rarely been addressed and remain poorly understood. We compared three reaches of the third-order, gravel-bed river Ruhr in Germany: two reaches restored with moderate (R1) and substantial effort (R2) and one upstream degraded reach (D). Hydromorphology, habitat composition, and hydrodynamics were assessed. We estimated gross primary production (GPP) and ecosystem respiration (ER) using the one-station open-channel diel dissolved oxygen change method over a 50-day period at the end of each reach. Moreover, we estimated metabolic rates of the combined restored reaches (R1 + R2) using the two-station open-channel method. Values for hydromorphological variables increased with restoration intensity (D

Increased fine sediment deposition is recognised as one of the major causes of biological impairment of rivers and streams influencing all components of aquatic communities. Notably, stream macroinvertebrates are affected showing changes in abundance and community composition. This makes macroinvertebrates an attractive choice for biomonitoring fine sediment stress. However, there are substantial knowledge gaps regarding the quantification of deposited fine sediment and the identification of taxa sensitive to fine sediment deposition, which could serve as indicators. In this study, we developed a stream type-specific index based on the taxon-specific response of macroinvertebrates to deposited fine sediment in small, coarse substrate-dominated mountain streams. We sampled fine sediment at 73 sampling sites in Western Germany (Europe) in spring 2014 and 2015 using a sediment remobilization technique. Macroinvertebrate taxalists originating from WFD monitoring surveys were available for all sites. We applied Threshold Indicator Taxa ANalysis (TITAN) on the fine sediment mass of the sampling sites and the corresponding macroinvertebrate taxalists to identify indicator taxa, which were then used for index development. In total, TITAN identified 95 reliable indicator taxa, of which some taxa tolerated large amounts of fine sediment (e.g., Gammarus roeselii and Tubificidae Gen. sp.), while others were found to be highly sensitive to increased fine sediment mass (e.g., Elodes sp. and Limnius perrisi). The newly developed index was tested on an independent data set and performed well in detecting fine sediment stress (Spearman's r = 0.63). Furthermore, the index was better related to the deposited fine sediment mass as compared to other fine sediment indices and standard metrics used for monitoring purposes under the Water Framework Directive (WFD). The diagnostic index can be a cost-effective biomonitoring tool for stream managers and can be used as a proxy for the impact of deposited fine sediment on the reach scale.

AIMS: Carotid intima media thickness (CIMT) predicts cardiovascular (CVD) events, but the predictive value of CIMT change is debated. We assessed the relation between CIMT change and events in individuals at high cardiovascular risk. METHODS AND RESULTS: From 31 cohorts with two CIMT scans (total n = 89070) on average 3.6 years apart and clinical follow-up, subcohorts were drawn: (A) individuals with at least 3 cardiovascular risk factors without previous CVD events, (B) individuals with carotid plaques without previous CVD events, and (C) individuals with previous CVD events. Cox regression models were fit to estimate the hazard ratio (HR) of the combined endpoint (myocardial infarction, stroke or vascular death) per standard deviation (SD) of CIMT change, adjusted for CVD risk factors. These HRs were pooled across studies. In groups A, B and C we observed 3483, 2845 and 1165 endpoint events, respectively. Average common CIMT was 0.79mm (SD 0.16mm), and annual common CIMT change was 0.01mm (SD 0.07mm), both in group A. The pooled HR per SD of annual common CIMT change (0.02 to 0.43mm) was 0.99 (95% confidence interval: 0.95-1.02) in group A, 0.98 (0.93-1.04) in group B, and 0.95 (0.89-1.04) in group C. The HR per SD of common CIMT (average of the first and the second CIMT scan, 0.09 to 0.75mm) was 1.15 (1.07-1.23) in group A, 1.13 (1.05-1.22) in group B, and 1.12 (1.05-1.20) in group C. CONCLUSIONS: We confirm that common CIMT is associated with future CVD events in individuals at high risk. CIMT change does not relate to future event risk in high-risk individuals. The PROG-IMT project, which includes this publication, has been funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, www.dfg.de) under the grants DFG Lo 1569/2-1 and DFG Lo 1569/2-3, received by MWL. The DFG had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Simon Thompson is supported by the British heart Foundation (CH/12/2/29428). Some of the contributing studies were funded by different parties, as listed in the acknowledgement section. Here, too, the funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Sí

Reintroduction is a common conservation strategy although rarely conducted in freshwater ecosystems. We present a reintroduction approach for freshwater invertebrates. Different natural substrates and exposure times were tested for presence and abundance of stream type specific macroinvertebrates. Wood leaf mixture demonstrated statistically significant highest mean abundances compared to other substrates. Moreover, they displayed comparatively high mean numbers when exposed for six weeks. We thus propose a natural substrate exposure method for reintroduction of aquatic insects.

Species reintroductions - the translocation of individuals to areas in which a species has been extirpated with the aim of re-establishing a self-sustaining population - have become a widespread practice in conservation biology. Reintroduction projects have tended to focus on terrestrial vertebrates and, to a lesser extent, fishes. Much less effort has been devoted to the reintroduction of invertebrates into restored freshwater habitats. Yet, reintroductions may improve restoration outcomes in regions where impoverished regional species pools limit the self-recolonisation of restored freshwaters. We review the available literature on macroinvertebrate reintroductions, focusing on identifying the intrinsic and extrinsic factors that determine their success or failure. Our study reveals that freshwater macroinvertebrate reintroductions remain rare, are often published in the grey literature and, of the attempts made, approximately one-third fail. We identify life-cycle complexity and remaining stressors as the two factors most likely to affect reintroduction success, illustrating the unique challenges of freshwater macroinvertebrate reintroductions. Consideration of these factors by managers during the planning process and proper documentation - even if a project fails - may increase the likelihood of successful outcomes in future reintroduction attempts of freshwater macroinvertebrates.

Considerable uncertainty exists regarding the ability of reach-scale habitat restorations to promote ecological integrity and affect community composition in degraded streams and rivers and the time scales at which these effects take place. Restoration of habitats on the reach scale (hundreds of meters to a few kilometers) is expected to support threatened species because many of them are habitat specialists. In contrast, generalist species are predicted to be replaced in restored reaches. We used a large data set for 62 reach-scale restoration projects in 51 stream systems in Germany, Switzerland, and Liechtenstein and analyzed the changes in fish community composition induced by the restorations in terms of species richness, species turnover, Brillouin diversity index, total fish abundance, and proportion of alien and endangered species. We further analyzed the temporal dynamics of the fish community recovery over a period of 19 y postrestoration. Species richness and Brillouin diversity index increased in most of the restoration projects (66 and 57%, respectively), but recovery to historical reference conditions was not achieved. Total abundance was enhanced by most of the projects. Species composition in restored reaches underwent directed shifts for at least 10 y, with high and variable species turnover in the first years that decreased over time. The effects of restoration on Brillouin diversity index were highly variable in the first few years after restoration, but tended to increase over time. These dynamics must be considered more carefully in future protocols for evaluating restoration results, and final evaluation of restoration outcomes on fish communities should not be made too early. Our results indicate that reach-scale habitat restorations may be a suitable tool for increasing local fish abundance and slightly enhancing species diversity. However, more targeted approaches are needed to support threatened species and repress alien species.

Two ultrasound tests that can be used to assess increased intracranial pressure (ICP) at the bedside are described. In outpatients receiving lumbar puncture and in intensive care patients with invasive ICP monitoring, we measured the optic nerve sheath diameter (ONSD) with transbulbar B-mode sonography and septum pellucidum undulation (SPU) induced by repeated passive head rotation with transtemporal M-mode sonography. We assessed the sensitivity and specificity of ONSD and SPU in the prediction of ICP >20 cm H2O. For ONSD, sensitivity was 53% and specificity 100% (n = 35, p < 0.001). The sensitivity of the SPU test was 75% and the specificity 100% (n = 32, p < 0.001). Although the SPU test may not feasible in some patients, it has high sensitivity and specificity comparable to those of ONSD measurement. The SPU test and ONSD may be useful alternatives to fundoscopy in clinical routine, preferably in combination.

Studies investigating changes in community composition in response to recent global warming are mostly restricted to one-dimensional (e.g. elevational or latitudinal) gradients, whereas species movements are in reality three dimensional (i.e. elevational, latitudinal and longitudinal). Based on 3,245 benthic invertebrate samples from Central European streams over large elevational, latitudinal and longitudinal gradients during the period from 1986 to 2009, we developed an advanced community temperature index (CTI). This CTI enables the analysis of three-dimensional community range shifts not only in freshwater but also in marine and terrestrial environments. Overall, in contrast to terrestrial communities, benthic invertebrate communities have been able to keep up with recent global warming. However, their ability to track temperature shifts differed grossly between the three spatial dimensions, with the strongest response to elevation. Nevertheless, the price these communities had to pay was high, as total benthic invertebrate abundance and richness in cold-dwelling species have already declined by 21% and 52.5%, respectively. Our approach emphasizes the complex reaction of aquatic communities towards increasing temperatures, allowing a more complete picture of the subtle community shifts in response to global warming.

Hydromorphological restructuring of river sections, i.e. river restoration measures, often has little effects on aquatic biota, even in case of strong habitat alterations. It is often supposed that the biotic response is simply delayed as species require additional time to recolonize the newly generated habitats and to establish populations. To identify and specify the supposed lag time between restoration and biotic response, we investigated 19 restored river reaches twice in a five-year interval. The sites were restored one to ten years prior to the first sampling. We sampled three aquatic (fish, benthic invertebrates, macrophytes) and two riparian organism groups (ground beetles and riparian vegetation) and analyzed changes in assemblage composition and biotic metrics. With the exception of ground beetle assemblages, we observed no significant changes in richness and abundance metrics or metrics used for biological assessment. However, indicator taxa for near-natural habitat conditions in the riparian zone (indicators for regular inundation in plants and river bank specialists in beetles) improved significantly in the five-year interval. Contrary to general expectations in river restoration planning, we neither observed a distinct succession of aquatic communities nor a general trend towards "good ecological status" over time. Furthermore, multiple linear regression models revealed that neither the time since restoration nor the morphological status had a significant effect on the biological metrics and the assessment results. Thus, the stability of aquatic assemblages is strong, slowing down restoration effects in the aquatic zone, while riparian assemblages improve more rapidly. When defining restoration targets, the different timelines for ecological recovery after restoration should be taken into account. Furthermore, restoration measures should not solely focus on local habitat conditions but also target stressors acting on larger spatial scales and take other measures (e.g. species reintroduction) into consideration.

The honeydew composition and production of four aphid species feeding on Tanacetum vulgare, and mutualistic relationships with the ant Lasius niger were studied. In honeydew of Metopeurum fuscoviride and Brachycaudus cardui, xylose, glucose, fructose, sucrose, maltose, melezitose, and raffinose were detected. The proportion of trisaccharides (melezitose, raffinose) ranged between 20% and 35%. No trisaccharides were found in honeydew of Aphis fabae, and honeydew of Macrosiphoniella tanacetaria consisted of only xylose, glucose and sucrose. M. fuscoviride produced by far the largest amounts of honeydew per time unit (880 μg/aphid per hour), followed by B. cardui (223 μg/aphid per hour), A. fabae (133 μg/aphid per hour) and M. tanacetaria (46 μg/aphid per hour). The qualitative and quantitative honeydew production of the aphid species corresponded well with the observed attendance by L. niger. L. niger workers preferred trisaccharides over disaccharides and monosaccharides when these sugars were offered in choice tests. The results are consistent with the ants' preference for M. fuscoviride, which produced the largest amount of honeydew including a considerable proportion of the trisaccharides melezitose and raffinose. The preference of L. niger for B. cardui over A. fabae, both producing similar amounts of honeydew, may be explained by the presence of trisaccharides and the higher total sugar concentration in B. cardui honeydew. M. tanacetaria, which produced only low quantities of honeydew with no trisaccharides was not attended at all by L. niger.

Background Isolated transient vertigo can be the only symptom of posterior circulation ischemia. Thus, it is important to differentiate isolated vertigo of a cerebrovascular origin from that of more benign origins, as patients with cerebral ischemia have a much higher risk for future stroke than do those with ‘peripheral’ vertigo. The current study aims to identify risk factors for cerebrovascular origin of isolated transient vertigo, and for future cerebrovascular events. Methods From the files of 339 outpatients with isolated transient vertigo we extracted history, clinical and technical findings, diagnosis, and follow-up information on subsequent stroke or transient ischemic attack (TIA). Risk factors were analyzed using multivariate regression models (logistic or Cox) and reconfirmed in univariate analyses. Results On first presentation, 48 (14.2%) patients received the diagnosis ‘probable or definite cerebrovascular vertigo’. During follow-up, 41 patients suffered stroke or TIA (event rate 7.9 per 100 person years, 95% confidence interval (CI) 5.5–10.4), 26 in the posterior circulation (event rate 4.8 per 100 person years, 95% CI 3.0–6.7). The diagnosis was not associated with follow-up cerebrovascular events. In multivariate models testing multiple potential determinants, only the presentation mode was consistently associated with the diagnosis and stroke risk: patients who presented because of vertigo (rather than reporting vertigo when they presented for other reasons) had a significantly higher risk for future stroke or TIA (p = 0.028, event rate 13.4 vs. 5.4 per 100 person years) and for future posterior circulation stroke or TIA (p = 0.044, event rate 7.8 vs. 3.5 per 100 person years). Conclusions We here report for the first time follow-up stroke rates in patients with transient isolated vertigo. In such patients, the identification of those with cerebrovascular origin remains difficult, and presentation mode was found to be the only consistent risk factor. Confirmation in an independent prospective sample is needed.

Specialized neurological treatment decreases the mortality and morbidity of stroke patients. In many regions of the world an extensive coverage is not available. The cooperation between the Krankenhaus Nordwest (KHNW, Frankfurt, Germany) and the Government of Brunei Darussalam describes the set-up process of a specialized neurological center, including stroke unit, science and rehabilitation center.The aim of this project called to teach to treat - to treat to teach was to set up a center of excellence in neurology in Brunei Darussalam over a distance of 12,000 km. Treatment options were elucidated by teaching and taught by case examples.The construction of the Brunei Neuroscience Stroke and Rehabilitation Center (BNSRC) began in July 2010. To overcome the large distance between the department of neurology and neuroradiology at the KHNW and the BNSRC, a telemedical network was established. We provided daily teleteaching for all professions involved in patient care as well as 24/7 availability of teleneurological services from Germany to support the local team on site.In the BNSRC unit over 1000 patients with ischemic and hemorrhagic stroke and all the various acute neurological conditions were treated from July 2010 until July 2016 as inpatients and over 5000 were treated as outpatients. Since 2010, a total of 52 patients with stroke were treated by thrombolysis within the thrombolytic window and 81 hemicraniectomies were performed.The project has shown that it is possible to convey specialized neurological knowledge over large distances to provide significant benefits for patients and caregivers.

Background The relation of a single risk factor with atherosclerosis is established. Clinically we know of risk factor clustering within individuals. Yet, studies into the magnitude of the relation of risk factor clusters with atherosclerosis are limited. Here, we assessed that relation. Methods Individual participant data from 14 cohorts, involving 59,025 individuals were used in this cross-sectional analysis. We made 15 clusters of four risk factors (current smoking, overweight, elevated blood pressure, elevated total cholesterol). Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) between clusters using those without any of the four risk factors as reference group. Results Compared to the reference, those with 1, 2, 3 or 4 risk factors had a significantly higher common CIMT: mean difference of 0.026 mm, 0.052 mm, 0.074 mm and 0.114 mm, respectively. These findings were the same in men and in women, and across ethnic groups. Within each risk factor cluster (1, 2, 3 risk factors), groups with elevated blood pressure had the largest CIMT and those with elevated cholesterol the lowest CIMT, a pattern similar for men and women. Conclusion Clusters of risk factors relate to increased common CIMT in a graded manner, similar in men, women and across race-ethnic groups. Some clusters seemed more atherogenic than others. Our findings support the notion that cardiovascular prevention should focus on sets of risk factors rather than individual levels alone, but may prioritize within clusters., published version, peerReviewed

Numerous river restoration projects have been undertaken to improve the hydromorphology of rivers and their floodplains. Subsequent ecological monitoring is usually restricted to instream quality assessment while riparian areas and floodplains are rarely assessed. A good indicator for riparian assessment could be vegetation as its diversity is dependent on functioning hydromorphological processes. We used a comparative survey to test the effect of newly created river morphological features on riparian plant composition at restored reaches relative to non-restored reaches. We investigated 43 larger river restoration projects in Western Germany, realized between 1987 and 2008. The vegetation surveys were conducted between 2005 and 2013. We hypothesized that a) morphological river restoration leads to the diversification of riparian vegetation, higher reach-scale habitat heterogeneity and optimized habitats. These changes will b) be reflected by ecological preferences indicating hydromorphological functioning. We detected significantly higher species diversity in restored reaches. New habitats and hydrological interactions in the active channel and with the floodplains were fundamental, with the latter indicated by species preferences. In restored reaches we observed higher percentages of plants indicating regular flooding, significantly higher mean moisture tolerances and an extended range of moisture preferences. Conclusions Morphological river restoration can diversify and fundamentally influence riparian vegetation. Ecologically meaningful projects should address the rehabilitation of abiotic processes, focusing on a functioning flooding regime and near-natural riparian habitats. Riparian vegetation will reflect the improvements and consequently could be used as an indicator for restoration efforts. Thus, riparian vegetation assessment is worthy of consideration through legal obligations.

Background and Purpose— Because of a low prevalence of severe carotid stenosis in the general population, screening for presence of asymptomatic carotid artery stenosis (ACAS) is not warranted. Possibly, for certain subgroups, screening is worthwhile. The present study aims to develop prediction rules for the presence of ACAS (>50% and >70%). Methods— Individual participant data from 4 population-based cohort studies (Malmö Diet and Cancer Study, Tromsø Study, Carotid Atherosclerosis Progression Study, and Cardiovascular Health Study; totaling 23 706 participants) were pooled. Multivariable logistic regression was performed to determine which variables predict presence of ACAS (>50% and >70%). Calibration and discrimination of the models were assessed, and bootstrapping was used to correct for overfitting. Results— Age, sex, history of vascular disease, systolic and diastolic blood pressure, total cholesterol/high-density lipoprotein ratio, diabetes mellitus, and current smoking were predictors of stenosis (>50% and >70%). The calibration of the model was good confirmed by a nonsignificant Hosmer and Lemeshow test for moderate ( P =0.59) and severe stenosis ( P =0.07). The models discriminated well between participants with and without stenosis, with an area under the receiver operating characteristic curve corrected for over optimism of 0.82 (95% confidence interval, 0.80–0.84) for moderate stenosis and of 0.87 (95% confidence interval, 0.85–0.90) for severe stenosis. The regression coefficients of the predictors were converted into a score chart to facilitate practical application. Conclusions— A clinical prediction rule was developed that allows identification of subgroups with high prevalence of moderate (>50%) and severe (>70%) ACAS. When confirmed in comparable cohorts, application of the prediction rule may lead to a reduction in the number needed to screen for ACAS.